This chapter aims to highlight the importance of an integrated approach to pelvic floor (PF) practice. This facilitates adequate assessment of conditions across the three pelvic compartments, carefully selecting those patients who may benefit from surgery, optimizing conservative management preoperatively, and improving function postoperatively, as well as understanding and supporting the social, psychological and sexual impact of PF conditions. Creating a robust multidisciplinary team (MDT) offers advantages to both patients and healthcare providers, and is a defining feature of an established PF service.

The PF MDT needs to be inclusive. Surgical input should be provided by colorectal surgeons and appropriate specialists to cover urological and gynecological needs, and in many institutions this will be provided by a urogynecologist. However, a proportion of patients will be male or require specific expertise that can only be provided by a urologist with an interest in functional conditions. It is valuable to have more that one representative from each subspecialty but smaller services may be unable to achieve this. The MDT should have a clinical lead and administrative infrastructure to support audit and research. Core membership should contain PF physiologist and specialist nurses. This is the heart of the MDT through which patients are assessed and investigated, as well as introducing advice and conservative management at an early stage. The increasing use of neuromodulation (sacral nerve stimulation and posterior tibial nerve stimulation) demands highly trained individuals to motivate patients and optimize treatment. The PF nurse is ideally placed to deliver these treatments and explore the use of other approaches such as retrograde irrigation. Everyone involved in a PF practice is aware of the sensitive nature of the conditions and the potential relationship to psychological and sexual problems. Sexual abuse can be a significant etiological contributor to PF dysfunction and all members of the MDT need to be aware of opportunities to explore this; however, it is most often the PF nurse who is able to foster the close relationship and create the best opportunity to for this. Many relationships suffer the consequences of sexual problems as a result of PF dysfunction, particularly fear of leakage and pelvic pain during intercourse. Considerable support is needed to help women and their partners understand and cope with these difficulties. This can be provided by any member of the team with regular patient contact; however, it is often the specialist nurse who establishes rapport with patients to facilitate these discussions.

Good communication with obstetric and midwifery teams is important although they need not be core members of the MDT. This allows shared protocols for management of PF conditions early in the postpartum period, deciding who should be responsible for the management of acute pelvic floor and sphincter injuries and offering patients a seamless pathway of care to the colorectal service if problems persist. Clear guidelines and protocols are helpful in defining indications for caesarian section and vaginal delivery in patients with persisting PF problems either from previous obstetric injury or those with gastrointestinal conditions, e.g., previous or anticipated ileal pouch surgery in ulcerative colitis or polyposis.